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  • Title: Intra-amniotic urea and prostaglandin F2alpha for midtrimester abortion: clinical and laboratory evaluation.
    Author: King TM, Dubin NH, Atienza MF, Burkman RT, Blake DA, Baros NA.
    Journal: Am J Obstet Gynecol; 1977 Dec 01; 129(7):817-24. PubMed ID: 75692.
    Abstract:
    The clinical management of the elective midtrimester abortion continues to be unsatisfactory as judged by either national mortality or morbidity rates. This report documents the results of a randomized series of 19 midtrimester abortions induced by either intra-amniotic hyperosmolar urea and 5 mg. of prostaglandin F2alpha (PGF2alpha) or intra-amniotic hyperosmolar urea alone. Pertinent clinical characteristics and biochemical determinations were compared between these two groups. A series of 150 patients were then treated with urea and 5 mg. of PGF2alpha. The clinical results of this series of patients are presented and compared with a previous group who had urea and 10 mg. of PGF2alpha. These studies demonstrate that 5 mg. of PGF2alpha with 80 Gm. of urea achieves injection-abortion intervals that are less than 24 hours. Intraamniotic urea and prostaglandin F2 alpha (PGF2a) combinations for midtrimester abortion were compared in the following series: 8 multiparas given 80 gm urea in 135 ml 5% dextrose and 5 mg PGF2a, 8 multiparas given urea only, 150 nulliparas and multiparas given urea and 5 mg PGF2a, and 180 given urea and 10 mg PGF2a. In the 2 small series, there was 1 failure in the urea group. Mean abortion times were 28.8 hours after urea, 18.3 hours after urea and 5 mg PGF2a, and 16.3 and 17.5 hours in the 2 large series given urea and 10 and 5 mg PGF2a, respectively. Urea caused loss of fetal heart tones within 2 hours, had a half-life in amniotic fluid of 3 hours, caused a low frequency of late emesis, and resulted in short-lived burning or warm sensation in 1 case of accidental intravascular injection. Oxytocin infusions were used frequently for failure to abort within 24 hours, or lack of uterine contractions after membrane rupture or incomplete abortion. PGF2a accelerated uterine tone, frequency, and integrated uterine pressure over the values measured in subjects given urea only.
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